Employer Intern Request Form

Business Name (required)
Address (required)
City (required)
State (required)
Zip Code (required)
Phone (Area Code) (required)
Fax
Website
Company Description (required)
Is this a Home Based Business? yes    no
How many employees do you
have on site?
Internship Supervisor First Name (required)
Internship Supervisor Last Name (required)
E-mail (required)
Title of Supervisor (required)
Department
Are you an Alumni of MiraCosta College? Yes   No
Would you like to be contacted about getting involved in any/all of these MCC activities?








Intern/Job Title (required)
Internship Description: Duties & Responsibilities (required)
Experience/Opportunities that will be Acquired (required)
Desired Qualifications & Skills (required)
(Please include any special requirements ie: Background Check, Fingerprinting, etc.)
Application Instructions (required)
Start Date
Industry Type (required)
Job Function (required)
Please list the major(s) applicable to your position to maximize student recruitment.
Hold Ctrl key to select multiple majors
Is this a paid internship? Yes   No
Rate of Pay $ (required) (if non-paid enter 0.00)
Hours Per Week (required)
Length of Internship (required)
How long would you like this position posted? (maximum one year) (required)
Number of positions available (required)